Rapid advances in the development of medical devices in the 21st century are contributing to healthier lives, but bring with them a new challenge: teaching clinicians how to use these often-complicated technologies. Teaching them poorly, or failing to do it at all, can negate the potential benefits and put patients at risk of harm from devices that were intended to benefit them.
A surgeon once needed to perform 10 to 20 cases to reach proficiency in a new procedure. But as complexity has increased, that number has grown to 50 to 100 cases. The existing system of surgical training is starting to show cracks, as up to 30% of graduating general surgery residents are unable to operate independently.
Leaders in health care quality often look to the aviation industry for inspiration. It has leveraged simulation and other technologies and processes to achieve a remarkably high bar for safety. Though worldwide flight hours have doubled over the last 20 years, airline fatalities have fallen by almost 45 percent. Sadly, we’re not having the same success in medicine, where medical errors are the third leading cause of death.
Can medicine replicate the safety success of aviation? Recent advances in virtual reality, augmented reality, and mobile technology offer the promise of accelerating the learning curve for new medical technologies.
When I was a surgical resident, I watched how dependent surgeons were on medical device reps in the operating room to safely use new devices or devices they weren’t completely familiar with. Several times I was asked to help an attending surgeon by Googling how to use a device in the middle of an operation. I constantly wished there was a better way to practice procedures before doing them in the operating room.
During my surgical residency, I became involved in the virtual reality renaissance catalyzed by the Oculus Rift, a user-friendly virtual reality environment with a far more immersive experience than the VR headsets before it. I immediately saw its incredible potential to solve the training problem in surgery.
Simulators are a way for surgeons to practice, but they are expensive and typically simulate only a single procedure. VR has revolutionized simulation by being more accessible, effective, and affordable. Its portability and ease of use open the door for practicing skills and techniques anytime, anywhere. All a surgeon needs is a headset the size of ski goggles and a motion controller for each hand.
In order for VR surgical simulation to be accepted by the notoriously conservative world of health care, solid research must demonstrate that it improves surgical skills. Such studies are underway. Researchers at the David Geffen School of Medicine at the University of California, Los Angeles, for example, recently validated VR-based surgical training using technology developed by my company for a procedure for repairing a bone fracture.
In the study, which was recently presented at the annual meeting of the Western Orthopedic Association, medical students who were given VR training for the procedure completed it 20% faster and completed 38% more steps correctly than those in the traditionally trained group.
Augmented reality differs from the virtual reality experience by augmenting and overlaying the real clinical environment rather than placing a surgeon in a virtual world. There are a range of such technologies, including mobile variants like Pokemon Go, holographic headset displays like the HoloLens, and heads-up displays like Google Glass.
Here’s one way that augmented reality can be used: Surgeons often seek the advice of experts when facing complex or unfamiliar cases. Interaction with those experts is often via email, phone, or even text message before or after the procedure. Telementoring, a leading use of AR, allows the expert to see what the surgeon is seeing and provide tailored guidance during the procedure.
Other exciting uses of AR during surgery include navigation solutions, like those from Medivis and Augmedics. These augment surgeons’ vision so they can effectively see through patients and increase their precision, essentially providing “X-ray vision.” Augmented reality headsets can also collect video data from the operating room which, with the assistance of machine learning, is being used to make automated recommendations, such as highlighting critical structures to be aware of to ensure they are not damaged, coordinate the surgical team, and assess surgical skills during a procedure.
Relatively straightforward technology holds a lot of promise for surgical safety and efficiency. Coordinating a surgical team can sometimes create miscommunication, risk, and inefficiency in the operating room. Team members are often swapping in and out in the middle of a procedure, and they can be disoriented about what they’re supposed to be doing.
ExplORer Surgical has created an easy-to-use system to address this issue. Each member of the surgical team has an iPad with personalized instructions on what step in a surgery the team is on. A “conductor” simply swipes when they are ready to move on to the next step, ensuring the entire team is in sync.
The future of surgical work
A report from the World Health Organization that analyzed the challenges of increasing complexity in medical technology noted that improper training and longer learning curves are the primary reasons for adverse events related to new technologies. So it is essential that we take swift action to improve training, assessment, and coordination of surgical teams.
We are already starting to see blowback in some areas of innovation related to insufficient training and assessment. For example, in a trial called SYMPLICITY HTN-3, investigators were evaluating a device that could potentially cure high blood pressure by cutting some nerves to the kidneys. The study ultimately showed no benefit. Yet a retrospective analysis noted that one of the reasons the study failed was that 30% of the physicians who took part in the trial had performed this complex procedure just once before the trial, and half had done it no more than twice.
If we don’t solve problems related to training and assessment, we may be delaying or even shutting down promising emerging medical technologies.
It is up to innovators to collaborate with patients, institutions, industry, professional organizations, and regulatory bodies to recognize the challenges around the rapid introduction of valuable yet complex new technologies. Improving training and communication with virtual reality, augmented reality, and mobile apps can help ensure safer surgery and allow innovations to reach their full potential in the health care system.
Justin Barad, M.D., is an orthopedic surgeon and co-founder and CEO of Osso VR.